Shaw Leslee J, Merz C Noel Bairey, Pepine Carl J, Reis Steven E, Bittner Vera, Kip Kevin E, Kelsey Sheryl F, Olson Marian, Johnson B Delia, Mankad Sunil, Sharaf Barry L, Rogers William J, Pohost Gerald M, Sopko George
Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif, USA.
Circulation. 2006 Aug 29;114(9):894-904. doi: 10.1161/CIRCULATIONAHA.105.609990. Epub 2006 Aug 21.
Coronary angiography is one of the most frequently performed procedures in women; however, nonobstructive (ie, < 50% stenosis) coronary artery disease (CAD) is frequently reported. Few data exist regarding the type and intensity of resource consumption in women with chest pain after coronary angiography.
A total of 883 women referred for coronary angiography were prospectively enrolled in the National Institutes of Health--National Heart, Lung, and Blood Institute--sponsored Women's Ischemia Syndrome Evaluation (WISE). Cardiovascular prognosis and cost data were collected. Direct (hospitalizations, office visits, procedures, and drug utilization) and indirect (out-of-pocket, lost productivity, and travel) costs were estimated through 5 years of follow-up. Among 883 women, 62%, 17%, 11%, and 10% had nonobstructive and 1-vessel, 2-vessel, and 3-vessel CAD, respectively. Five-year cardiovascular death or myocardial infarction rates ranged from 4% to 38% for women with nonobstructive to 3-vessel CAD (P < 0.0001). Five-year rates of hospitalization for chest pain occurred in 20% of women with nonobstructive CAD, increasing to 38% to 55% for women with 1-vessel to 3-vessel CAD (P < 0.0001). The volume of repeat catheterizations or angina hospitalizations was 1.8-fold higher in women with nonobstructive versus 1-vessel CAD after 1 year of follow-up (P < 0.0001). Drug treatment was highest for those with nonobstructive or 1-vessel CAD (P < 0.0001). The proportion of costs for anti-ischemic therapy was higher for women with nonobstructive CAD (15% versus 12% for 1-vessel to 3-vessel CAD; P = 0.001). For women with nonobstructive CAD, average lifetime cost estimates were $767,288 (95% CI, $708,480 to $826,097) and ranged from $1,001,493 to $1,051,302 for women with 1-vessel to 3-vessel CAD (P = 0.0003).
Symptom-driven care is costly even for women with nonobstructive CAD. Our lifetime estimates for costs of cardiovascular care identify a significant subset of women who are unaccounted for within current estimates of the economic burden of coronary heart disease.
冠状动脉造影是女性中最常进行的检查之一；然而，非阻塞性（即狭窄<50%）冠状动脉疾病（CAD）的报告频率较高。关于冠状动脉造影后胸痛女性的资源消耗类型和强度的数据很少。
共有883名接受冠状动脉造影的女性被前瞻性纳入美国国立卫生研究院 - 国立心肺血液研究所资助的女性缺血综合征评估（WISE）研究。收集了心血管预后和成本数据。通过5年的随访估计了直接（住院、门诊就诊、检查和药物使用）和间接（自付费用、生产力损失和交通费用）成本。在883名女性中，分别有62%、17%、11%和10%患有非阻塞性CAD以及单支血管、双支血管和三支血管CAD。非阻塞性至三支血管CAD女性的5年心血管死亡或心肌梗死发生率为4%至38%（P<0.0001）。非阻塞性CAD女性中20%出现胸痛住院5年发生率，单支血管至三支血管CAD女性的这一发生率增至38%至55%（P<0.0001）。随访1年后，非阻塞性CAD女性的重复导管插入术或心绞痛住院量比单支血管CAD女性高1.8倍（P<0.0001）。非阻塞性或单支血管CAD患者的药物治疗费用最高（P<0.0001）。非阻塞性CAD女性的抗缺血治疗费用比例更高（单支血管至三支血管CAD为12%，非阻塞性CAD为15%；P = 0.001）。对于非阻塞性CAD女性，平均终身成本估计为767,288美元（95%CI，708,480美元至826,097美元），单支血管至三支血管CAD女性的成本估计为1,001,493美元至1,051,302美元（P = 0.0003）。
即使对于非阻塞性CAD女性，症状驱动的治疗成本也很高。我们对心血管护理成本的终身估计确定了冠心病经济负担当前估计中未涵盖的大量女性群体。
